PROSTATES, PSA, PREVENTION, PARANOIA- FINDING THE BALANCE

September 3, 2017

In my work as a Urologist, I receive referrals to see patients to assess their risk of prostate cancer. There is a huge variation in men’s knowledge about the prostate and an even greater variation in their attitude towards detection and treatment. Thanks to many of the awareness organisations such as the Prostate Cancer Foundation, men are much more cognizant of the pesky problems of the prostate.

Two weeks ago i met a 69 year old gent who had never had a PSA Blood test. PSA stands for Prostate Specific Antigen. Though it’s not a perfect test by any means, it gives an indication about prostate cancer risk. This patients’ PSA came back at 32, his digital examination revealed a malignant feeling gland, and his biopsy showed high grade prostate cancer. If he’d had the test 10 years earlier, it may have been detected at a much earlier stage and been more easily treated.

Why didn’t he have the test? Firstly the patient was not too interested in prevention and had not even followed more fundamental tests such as blood pressure and cholesterol. Secondly, his GP did not “believe” in early detection of prostate cancer. Now I recognise there are issues with screening programs, early detection, over detection and potential harm from treatments, however, to neglect to make an assessment of risk and to revert back to “the dark ages” is simply stupidity in my opinion. My senior urology colleagues will testify that prior to the simple blood test becoming available, far more men presented with metastatic disease such as with spinal cord compression.

At the other spectrum I have patients with PSA paranoia. They get their blood test done every 3 months even when it is normal. They get their prostate examined every 6 months, even when we know that the digital examination doesn’t add that much to risk assessment and has even been dropped out of screening recommendations. They bring in elaborate graphs of their own PSA trends, velocity, dips and bumps. Their fixation on their prostate belongs to a health related anxiety disorder.

Clearly, the answer lies somewhere in the middle. Most urologists recommend a first PSA between age 40 and 45 to give a baseline level of risk. There is data that supports this. Though the digital rectal examination (DRE) has dropped out of the current guidelines, there is a very small percentage of men who may have a normal PSA and still harbour significant prostate cancer. My personal option is that the DRE be performed every 3 years. Not only may a prostate cancer be detected, but rectal tumours can also be found. Men with a family history have twice the risk of developing prostate cancer, and screening should start at age 40 in this group.

It’s Father’s Day here in Australia. We need our men healthy and happy. Find the right balance with your health prevention. Don’t put your head in the sand and ignore preventable and treatable illnesses. At the same time, don’t become a hypochondriac and worry about every potential problem. Live a well balanced healthy life with sound nutrition, plenty of physical activity, and maintenance of a happy mind. The rest of it is up to luck, fate, destiny or whatever you like to believe in!